Provider Demographics
NPI:1255359279
Name:BRULE, GEORGETTE LOUISE (LMHC)
Entity type:Individual
Prefix:
First Name:GEORGETTE
Middle Name:LOUISE
Last Name:BRULE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:GEORGETTE
Other - Middle Name:LOUISE
Other - Last Name:DELUCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 COLLEGE HILL RD STE 30F
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886
Mailing Address - Country:US
Mailing Address - Phone:401-884-0144
Mailing Address - Fax:401-884-0144
Practice Address - Street 1:33 COLLEGE HILL RD STE 30F
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-884-0144
Practice Address - Fax:401-884-0144
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00160101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health